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William ayers 897371 investigations creatinine 112 most recent creatinine in may '4 and prior to that in december electrolytes normal lft is normal d dimer 0.4 brackets negative close brackets full blood count normal venous blood gas normal ease 0 afebrile right swollen left leg ecg right bundle branch block left axis deviation er 208 milliseconds first degree atrioventricular block repeated mpi interval 188 milliseconds bifascicular block hi I'm mister william lewis yeah hi I'm doctor miller I'm norco radiology medical doctors how are you well I'm sorry why are you wrong his left leg is the problem yes you've had a knee replacement in it yes when was that about 18 months ago 18 months good and how did it all go alright yeah yeah and then when did this all happen well it started I'd say yesterday yes it is it all rolled up just it started with ache and then all of a sudden by the achy that yeah more obvious on my leg yeah it seemed to start there right so it's achy in your lower leg and then it became more swollen yeah where does the swelling go up to was there I think yeah doesn't go up any further no so the knee doesn't look swollen up doesn't it fusion in the joints feels okay it's all behind yeah very tender too bad sorry that's sore is it a little bit darker than the other side it doesn't look red and angry like it's infected can I have a look at your ankle you said your pain was down your ankle yeah that's really sore isn't it yeah that's and and what happened today how have you ended up here did you see the gp no I I just you know it just started I thought gee that's why I don't know what that is right but it was too late for the gp patients of course it's at some? Yeah I understand so I thought well I bought a guy called the desk so yeah I wanna go and see see what it is see if I gentle a and e and they sent you in here sorry what happened to his toe I didn't cross over again okay that 1 was the same but they used that 1 okay that 1 was used once you have that 1 they decided that they'd take it off yeah fair enough when was that it looks well healed doesn't it yeah it's fine no I'm not nothing's out once though how are you on your feet not good right I can get on there but if you don't want to I got my crutches there yeah fine you've had some blood tests since you came in and I've seen the results of them they were worried about a clot in your leg there's certainly no sign of a clot in your leg on that blood test your d dime is normal the rest of your tests are pretty unremarkable quite reassuring really I wonder whether you've got had a baker's cyst which is a cyst behind the knee and that's burst and that can often lead to this swelling in the leg mhmm but I'm it's certainly not my area of expertise I will talk to my orthopedic colleagues who is probably more their area of expertise and they may well come and see you and look at your leg and see what they think about it but it looks like you're in a pain at the moment yeah would you like something for it yeah okay what have you have you had some paracetamol or anything like that well I'm I'm I'm on a don't no that's you brought any of it with you no no that's okay because I I didn't think I'd be the other I'll have a look at what medicines you're on if we've got any of those in the cover they'll try and top you off on it so you don't miss it and I'll get you some painkillers as well is that alright you haven't had paracetamol today yeah they no I no no what is it I I think I don't know they gave me a couple today early on you know they they don't do do nothing nothing no okay not really are you allergic to anything no tell me about your life more generally yeah does anyone live at home with you yeah the wife yeah the wife yeah fine yeah what do you do for a living yeah I think I'm retired now retired oh I'm 80 now yeah yeah what did you do before taxi I I used to be a trucker yeah cool I was a trucker and I was an abbey transport you know yeah dump trucks mhmm yeah fine and on the channel tunnel was on that oh really fine yeah I was on that for 2 years I did the falklands I've done that built the airfield out there wow amazing cool yeah in all over germany working all over germany the boys of the blacks as they call it yeah fine okay yeah very good old life yeah amazing and do you drink or smoke smoke drink but not not a lot yeah you know but when I say smoke roughly but we just I'd I'd say I'm a social smoker mhmm you know I could do sunday monday tuesday 20 30 friday yeah without a cigarette that's fine then I'll have her out for a drink or someone come by the house can I have a key we just have a a couple yeah I understand fine nothing regular no you can have alcohol same with the same with yeah the hey lily squeeze it into the back oh yeah on that I told you it's not right yep do that thank you how about the third you had the achilles tendon rupture before I see it yeah that's right but on the other side fine does this feel like that yeah that's what it does feel like back in my cat for you fine when I think of that I don't want to go weight training you know what when you're what was weight training oh right okay yeah what you say and it just like snap yeah and I felt my goat but this I haven't felt goat you know what mean yeah I haven't felt anything started with the ankle yeah exactly same with the ankle yeah if I push your foot back you you're not having that no that's very sore yeah if I bring your foot down yeah I'm that's okay yeah alright let's not worry but if I try and stretch it up very painful okay fine it's good to know I'll ask my orthopedic colleagues to come and have a look at you and see what they think make sure you've got some papers and stuff like that and take it from there you've had a we've had a tracing of your heart which looks fine by the way and and like I said I told you about your blood tests mean you haven't had any other tests done by the looks of it that I can tell you the results of I haven't seen you good no great any questions or anything like that no no I don't think you've got anything medically wrong with your leg I think that's probably something with the achilles tendon or in the knee we'll I'll let my specialist colleagues work out what that is okay great I'll come back in a minute do you have a chance to leave your shoe off for a moment yeah now we've gone to the faff getting it off okay no you're good at that well we as long as we're done we're gonna have 1 on the back alright you too oh

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Medical ST5 Miller Clerking
[Current Date] [Current Time]

Presenting Complaint:
[The reason for attendance in 1-3 words]

History of Presenting Complaint:
[Chronological narrative of current illness using short, clear sentences. Include:
- Onset, character, location, radiation, timing, exacerbating/relieving factors
- Associated symptoms
- Impact on daily activities
- Previous similar episodes
- Relevant collateral history from relatives/carers
- Any relevant background from other healthcare professionals
Do not repeat patient's name throughout. Be concise and tell a chronological story to the reader. Do not include subjective descriptions of the symptoms e.g. "severe" or use unnecessarily long words.]

Past Medical History:
[Bulleted list of significant medical conditions with relevant details:]
• [Condition with year if mentioned]
• Diabetes mellitus - latest HbA1c: [value] mmol/mol ([date])
• Asthma/COPD - latest spirometry: FEV1 [value], FVC [value] ([date])
• [Previous surgeries with dates]
• [Other significant medical history]

Drug History:
• [Drug name] [dose][units] [route] [frequency]
• [Example: Omeprazole 20mg PO OD]
• [Example: Clopidogrel 75mg PO OD]

Recently Stopped Medications: [If relevant]
• [Medication] - stopped [date/reason]

Allergy History:
[If allergies mentioned:]
• [Allergen] - [Reaction type] ([severity if mentioned])
• NKDA [if no known drug allergies stated]

Social History:
[Living situation. Who they live with, housing type, if mentioned]
[Mobility. Walking aids, stairs, transfers, if mentioned]
[Carers. Formal/informal care arrangements, if mentioned]
[Occupation. Current/previous if relevant, if mentioned]
[Smoking. Never/Ex-smoker/Current - pack years if mentioned]
[Alcohol. Units per week/Never/Ex-drinker - if mentioned]
[Functional Status: Impact on activities of daily living, if mentioned]

On Examination:
[General Appearance. Alert, well/unwell, distressed, if mentioned]
Observations:: [If mentioned - HR, BP, Temp, RR, O2 sats (do not use subscripts)]
• Abdomen: [Inspection, palpation, percussion, auscultation findings. If not commented upon, document as normal]
• Cardiovascular: [Heart sounds, murmurs, peripheral pulses, oedema. If not commented upon, document as normal]
• Respiratory: [Chest expansion, percussion, auscultation. If not commented upon, document as normal]
• Neurological: [If examined.]
• Other: [Any other relevant examination findings, if mentioned]

Investigations:
• [Test name] ([date, if mentioned, do not include include today's date on results, list without a date]): [Result without units]
• [Example: Hb 85]
• [Imaging type] ([date, if mentioned]): [Key findings]
• [Example: CT Abdomen/Pelvis (15/03/24): Sigmoid diverticulosis, no perforation]

Impression:
[Main diagnosis]
Differential Diagnoses: [Only if multiple possibilities discussed]
[Secondary issues. Relevant comorbidities affecting management. If mentioned]

Management Plan:
1. [A numbered list documenting the management plan to be undertaken, if mentioned, include:
- Immediate management/monitoring,
- Investigation requests,
- Treatment interventions - medications, procedures,
- Discharge planning/follow-up arrangements,
- Patient education/lifestyle advice,
- Referrals to other specialties if needed,
- Which ward or specialty the patient would be best admitted to e.g. "Respiratory Bed",
- Escalation plan that was discussed - whether the patient is suitable for CPR, ITU and/or NIV.]

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